The effect of hemiarthroplasty implant modulus on contact mechanics: an experimental investigation.

Abstract

Hemiarthroplasties cause damage to the cartilage that they articulate against, which is a major limitation to their use. This study investigated the use of lower-stiffness materials to determine whether they improve hemiarthroplasty contact mechanics and thus reduce the risk of cartilage damage. Eleven fresh-frozen cadaveric upper extremities were disarticulated and fixed in a custom-built jig that applied a static load of 50 N to the radiocapitellar joint. Flexion angles of 0°, 45°, 90°, and 135° were tested with radial head implants made of cobalt-chrome (CoCr) and ultrahigh-molecular-weight polyethylene (UHMWPE) compared with the native radial head. A Tekscan thin-film sensor was used to measure the contact area and contact pressure between the radius and capitellum. UHMWPE and CoCr were too stiff in the application of hemiarthroplasty, resulting in lower contact areas and higher contact pressures relative to the native joint. The native contact area was, on average, 42 ± 20 mm2 larger than that of UHMWPE (P < .001) and 55 ± 24 mm2 larger than that of CoCr (P < .001). UHMWPE had a contact area 13 ± 10 mm2 greater than that of CoCr (P = .014). This study shows that even though UHMWPE has a stiffness several times lower than CoCr, the use of this material in hemiarthroplasty led to only a minor improvement in contact mechanics. Neither implant restored contact similar to the native articulation. Investigations into new materials to improve the contact mechanics of hemiarthroplasty should focus on materials with a lower stiffness than UHMWPE.